WASHINGTON (AP) — Like other HealthCare.gov customers, immigrants are relieved that the government's health insurance website is working fairly well this year. They're baffled, though, by what looks like an obvious lapse: There is no clear way to upload a copy of their green card, the government identification document that shows they are legal U.S. residents and therefore entitled to benefits under President Barack Obama's health care law.

President Obama’s top health official said Monday the health care law will overcome a Supreme Court challenge that argues the administration is illegally doling out subsidies to about two-thirds of the states.

HHS is hitting the malls this weekend to make sure that Obamacare is on the minds of consumers during the busiest shopping weekend of the year.

The department on Wednesday will announce new partnerships it has made with retail stores, pharmacies and popular websites to spread the word about the current open enrollment season, which began on Nov. 15 and ends Feb. 15. On three key days after Thanksgiving — Black Friday, Small Business Saturday and Cyber Monday — as well as dates beyond, Westfield Shopping Centers, the National Community Pharmacists Association and the XO Group will provide consumers with information about how they can sign up for coverage through the exchanges.

OK, technically not all of these are due specifically to ACA Medicaid expansion, but the majority of them should be, based on past reports. Unfortunately, it's my understanding that the Colorado exchange has decided to stop including Medicaid expansion data with their reports; hopefully this isn't the case, but assuming it is, this is the best I can do for now.

According to the CO Dept. of Healthcare Policy, as of October, the combined Medicaid/CHIP enrollment was 1,172,793:

In October 2014, there were 1,120,120 Coloradans enrolled in Medicaid and 52,673 Coloradans enrolled in CHP+.

Back in December 2013 (just prior to the expansion provision), Colorado had 862,549 people in these programs, a difference of 310,244.

I'm estimating that perhaps 40,000 of these are "woodworkers", the other 270K or so strict expansion.

According to KFF.org, roughly 332,000 Coloradans are eligible for the expansion program.

According to the state administration, there are roughly 477,000 Michiganders who qualify for Medicaid expansion under the Affordable Care Act. Well, guess what?

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 469,698
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

*Statistics as of November 24, 2014
*Updated every Monday at 3 p.m.

Now, obviously that 477K eligibility figure could be off (I had previously heard estimates as high as 500,000). The point is, the Medicaid expansion well in Michigan, along with many other states, is already running dry less than a year into the program (and in Michigan's case, less than 8 months in).

UPDATE: Hmmmm...ok, that's a first: According to today's update, the number enrolled in the Healthy Michigan program has actually dropped by around 8,500 people over the past week:

Last night I noted that both Alaska and Wyoming are strongly considering jumping in the ACA Medicaid expansion pool. If both go through, the number of states which have expanded the program would rise to 31 out of 51 (if you include DC). Tennessee is also considering an Arkansas-style "private Medicaid option".

I also mentioned in passing that one of the "existing" expansion states was Pennsylvania. I knew they were also talking about a "private option" program, but I wasn't sure what the status of the program was. I didn't think it was a done deal yet, but the Kaiser Family Foundation has already struck PA off of their "Medicaid Gap" list, so I'm including them in the tally.

Well, this morning, not one but two site supporters have confirmed that not only is PA definitely moving forward with that program, it might actually end up being "full" expansion instead of the "private option" after all...along with some other useful tidbits I didn't know about:

OK, I wasn't quite sure how to deal with the Medicaid Graph this year. On the one hand, there isn't any deadline or "open enrollment" period for enrolling in Medicaid/CHIP; it's year-round. On the other hand, there simply wasn't room to just keep the 2014 Graph running continuously, at least without making the relative scale between the QHP and Medicaid graphs completely out of whack.

In addition, as I noted when the September CMS Medicaid/CHIP report came out, my own estimate seemed to be running around 4.5% too high compared to the official government figures (they had 9.1 million + 950K from prior to 2014 as of 9/30 (around 10.05 million); I had it down as around 10.5 million, or 450K higher.

Therefore, I'm resolving both issues by picking up the 2015 graph right where the 2014 graph left off...but I've also knocked a couple hundred thousand off in order to at least partially account for the discrepancy. As a result, if you try putting the two side by side, there will be a mis-match of a few hundred thousand, but I can live with that.

On the campaign trail, Bill Walker made expanding the state’s Medicaid program under the Affordable Care Act one of his top priorities. He said he could make the decision without input from the state legislature:

“It’s up to the Governor to accept that.”

But when Walker takes office next month, will it really be so easy to expand a program that has been a tough sell in other conservative states?

Medicaid expansion would allow around 40,000 low income Alaskans– mostly childless adults, to receive health benefits. The federal government will pay 100 percent of the program until the end of 2016. After that, the state’s share will slowly increase to 10 percent by 2020. Walker has said the decision is a no-brainer, at least while the federal government is providing full funding.

Massachusetts continues to kick butt this time around in general, but I particularly like that they're providing a daily breakout of their enrollment data. Check today's out, which includes both Wednesday and Thanksgiving Thursday:

This story from the 27th isn't an official number, but it's consistant with the formal press release from a few days earlier which had CO's tally at 6,144 as of 11/22:

Enrollment in Connect for Health Colorado, a health-insurance exchange, opened Nov. 15, and more than 8,000 people are already enrolled. Only about 200 people had enrolled during the same period last year, according to a release from Connect for Health Colorado.

...Many residents re-enrolled this month, he said, and there are a “significant” number of new enrollees.

On November 24th I took a shot at estimating how many 2015 QHP (qualified health plans) had been enrolled in as of the first week of the new open enrollment period. Based on the extremely limited data I had available from a handful of state exchanges, I internally estimated it was probably close to 500,000 nationally...but in the interest of caution, publicly went with 410,000.

Since around 75% of the total enrollments are likely to come from the federal exchange (Oregon and Nevada have been added to it, adding 109,000 current enrollees, while Idaho has moved off onto their own exchange with only 76,000 currently enrolled), a simple extrapolation suggests that the *total* number as of 11/21 was actually more like 610,000.

As I keep hammering over and over, asking "How many have PAID??" is a perfectly reasonable question to ask...as long as you a) wait until after the payments in question are actually due and b) you make sure to be as comprehensive as possible, since payment rates can vary from state to state or even insurer to insurer.

If you don't, you end up with a big ol' pile of crap like the infamous GOP House Energy & Commerce Committee "report" from back in April which tried to claim only a 67% first month payment rate when the actual rate ended up being around 88%.

The good news: Enrollment in the ACA private Medicaid option program is up to 218K, about 7,000 higher than it was as of mid-October.The bad news: With the state legislature & governor's office being completely overrun by Republicans, the future of the program isn't looking great:

This may seem a bit anticlimactic after this morning's Healthcare.Gov news, but it actually just serves to underscore how great the 2015 open enrollment period is doing so far:

Again, assuming roughly 50% of all QHP determinations are already resulting in plan selections the same day (which was consistent for at least the first 8 days), this means that total QHP selections should be roughly: 16,186 + 3,770 + 15,562 = 35,518 x 0.5 = 17,759. Lop off a couple hundred to err on the side of caution and Massachusetts should have roughly 17,500 or more QHPs selected already.

Once again: In 2014 they only hit 32K total in 6.5 months.

Meanwhile, ACA Medicaid can claim credit for nearly 31,000 more people being added to the tally.

As noted ad infinitum, the 462K QHPs selected (aka "total" enrollments) do not mean paid enrollments. As I've noted many, many times before, the first premium payments for January aren't even due for a month and a half and even then, many insurance companies allow a grace period. Most people don't pay their cable or electric bill until just before it's due, so for the love of God, don't start with the "But how many have PAID???" nonsense until around mid-January (and even then, that will only apply to those whose policies start on January 1st. Don't start huffing & puffing about 1st premium payment rates for the total 2/15/15 number until at least March 15th or so, m'kay???)

The Obama administration says that nearly a half-million people selected insurance plans throughHealthcare.gov during the first week of Obamacare open enrollment, in mid-October. Nearly half (48 percent) were new customers who had not previously purchased coverage last year, suggesting that the law could widen its reach to more uninsured Americans in year two of coverage expansion.

The new numbers, released by Health and Human Services Wednesday, show a faster start to open enrollment this year than in 2013. Last year, during Healthcare.gov's botched launch, only 106,185 consumers selected health insurance plans during the entire first month of enrollment.

...These figures do not include those consumers using the 14 state-based exchanges, in places like California and New York, where the federal government does not run the insurance marketplace.

And they also do not necessary show total enrollment: those who selected a plan still need to send a first month's premium to their insurance plan in order for their coverage to kick in on January 1.

6 days ago, after the revelation that the HHS Dept. had overstated the actual number of people currently enrolled in ACA exchange healthcare policies by 393,000 people by double-counting dental plans, I posted a screed in which I blasted them for "jerking me around". At the time I assumed that they had deliberately padded the number in an attempt to keep the official number above the "magic" 7 million threshold.

I closed my diatribe with the following:

I'm going to continue updating the site because I believe that the Affordable Care Act, with all of its flaws and shortcomings, is still an important and substantial improvement over the system that we had before it.

I just wish that you guys had enough confidence in your own policies not to embellish the metrics...especially when they stand on their own just fine.

OK, I almost always cite my sources on data points, but in this case I can't. On the other hand, it's not anything eyebrow-raising either; someone in a position to know has confirmed that at least 1,000 people had enrolled in QHPs via at least one insurer in Pennsylvania as of 11/19.

Considering that PA enrolled over 300,000 people last year, and there are 10 companies participating on the exchange in the state anyway, this isn't a particularly shocking data point, so I'll leave it there, but I can at least add it to the spreadsheet for Pennsylvania, anyway.

I know I've been saying that the worst-performing state exchanges from last year seem to be overperforming this year, but this is still a jaw-dropper. Maryland has done a complete turnaround this year:

As of Nov. 24, 2014, more than 25,000 Marylanders have enrolled in quality and affordable health coverage since the open enrollment period began on Nov. 15.

With the successful launch of the upgraded MarylandHealthConnection.gov website, 25,780 individuals have enrolled, including 14,749 enrolled in qualified health plans and 11,031 in Medicaid. From Nov. 15 to Nov. 24, 32,744 consumer accounts were created; 29,546 calls were made to the Consumer Support Center, and 79,681 visited the application portal on the website.

For comparison: Last year, Maryland enrolled a total of 67,757 people in 6 1/2 months. They've now achieved 22% of that total in just 10 days.

Yesterday I posted the MA Health Connector's first weekly dashboard report, in which they confirmed that yes, almost precisely 50% of all QHP determinations are consistently resulting in actual QHP enrollments on that same day. This held true on opening weekend (52%...3,600 out of 6,972) and held firm at 50% even in the first 8 days (14,101 out of 28,175), so I'm now pretty confident that it will stay at least at 50% daily going forward (obviously it should increase as we approach 12/15, which is fine).

Having said that, I can now add two more days to the tally...11/23 & 11/24:

So, that's 14,101 confirmed through 11/22. Add to that 50% of the Monday & Tuesday numbers (4,330 total) and you get an additional 2,165, or 16,266 QHP enrollments total.

OK, it might be slightly lower than 50% even, but certainly above 16K.

I just got off the phone with Christopher Snowbeck of the Star Tribune in Minnesota, who informed me that MN has a rather unique state law which, combined with the company dropping out of the ACA exchange, could have a serious impact on up to 23,500 residents who enrolled in policies via PreferredOne earlier this year.

To recap: MNsure, Minnesota's ACA exchange, enrolled roughly 48,500 people in private policies as of April. Unlike the 16% national attrition rate since then, Minnesota's ACA policies have retained 97% of their enrollments as of October (it's still at around 47,000 as of now out of 55,000 total enrollees to date). About 60% (33,000) of the total were through PreferredOne, although according to my sources, a good 10K of these have already moved on to other types of coverage (either a competitor, ESI, Medicare, Medicaid or whatever).

So, that leaves around 23,500 people still currently enrolled in MNsure-based PreferredOne policies as of October 15th.

Thanks to Bob Doherty for providing links to 2 extremely handy tools from the Kaiser Family Foundation, which break down 2014 QHP ACA exchange enrollments by various demographic criteria.

The state-level spreadsheet is no different from my own 2014 spreadsheet, except that it also includes an updated estimate of the potentialpool of QHP enrollees within each state.

The zip code tool, however, is far more impressive, as it lets you search enrollment data by zip code and then provides all sorts of demographic info within that area (not zip code specifically, but County and "city area"). It tells you what percentage of the potential market has enrolled, and then breaks the numbers down by ethnicity, education level, gender and so on.

The work done on these tools is impressive. However, there are a couple of major problems with them which limit their usefulness:

No 2015 data yet, but at least this has an update to the ACA Medicaid expansion figure for Delaware, tiny though it might be:

In addition to the Health Insurance Marketplace, some residents might be eligible for coverage through Delaware’s expanded Medicaid program, which continues year-round. More than 9,000 individuals have received coverage under the Medicaid expansion in the past year.

OK, not sure if this number runs through Thursday, Friday or Saturday given the conflicting wording ("before the week was over"), so I'm playing it safe and going with Friday:

By Thursday, the exchange had received about 25,000 calls and greeted about 1,800 walk-in visitors at its Contact Center at 70 Royal Little Drive. Meanwhile, the HealthSource RI website received about 35,000 hits, half of them from new visitors, an indicator that many may be first-time customers.

All of that activity resulted in 1,850 renewals and 319 new customers before the week was over.

“We are about where we expected to be at this point,” said Director Christine Ferguson, “but we have a long way to go.”

There's also some updated 2014 data:

As of Nov. 1, two weeks before the start of open enrollment, about 26,300 Rhode Islanders were covered by individual and family plans through HealthSource RI. Another 2,400 people had obtained coverage their small employers offered via the exchange. In addition, close to 70,000 enrolled in Medicaid through HealthSource RI.

This is awesome. Remember how last week I was assuming that roughly 50% of those determined eligible for QHP enrollments likely had already gone ahead and done so each day? At the end of the week I pulled back from this and went with a more cautious 1/3.

Well, it turns out I had it right in the first place: Massachusetts is about to announce 14,101 QHPs actually selected as of Saturday, out of 28,175 determinations (essentially 50% on the nose)!

In addition, they're already up to 23,792 MassHealth (Medicaid) enrollments, which is also excellent.

(link provided soon...it's not even on their website yet!)

For context, Massachusetts is enrolling people in private policies eleven times faster than they did last year...and that includes the December & late March surges.

Put another way, in just 8 days MA has already enrolled about 44% as many people as they did in 200 days last time around.

Crud. The bulk of this article is about how Jonathan "Diarrhea of the Mouth" Gruber was partly behind Colorado's ACA enrollment projections. However, there's one paragraph deep into it which gives me a sad for an entirely unrelated reason:

Connect for Health no longer tracks the Medicaid sign-up numbers, communications director Luke Clarke said. And officials have said also that they do not have a firm indication how many people getting insurance through the exchange used to be uninsured, though the non-profit marketplace was designed to be a primary vehicle for insuring the uninsured.

(sigh) Here I am doing everything I can to improve the transparancy...ah, well...

Recently there was a nonsense survey published by Bankrate which tried to claim that half of the 6.7 million current ACA exchange enrollees have no intention of sticking with the exchanges. What made this particular survey particularly stupid was that it included anyone who had visited one of the exchange websites, not just those who actually, you know, enrolled in a policy through one.

A couple of days ago, a new poll from Morning Consult, which actually surveyed those who are enrolled through the ACA exchanges came up with much more sensible results:

A majority of voters who purchased insurance from an exchange intend to keep their plan for 2015, according to a new poll.

Morning Consult polling found that compared with three months ago, more respondents say they will keep their insurance plans next year. Fifty-two percent of registered voters say they’ll continue with their coverage, compared with 44 percent in September polling.

I posted Connecticut's first week QHP & Medicaid numbers a few days ago. However, thanks to Dan Mangan providing a direct link to the press release itself, I can now add one other data point: SHOP (Small Business) exchange enrollments already have over 1,000 enrolled employees in just the first week of the 2nd Open Enrollment period (1,003 to be precise)!

To get a sense of how dramatic this is, consider that as of July, Access Health CT had only 602 total covered lives in SHOP plans. The distinction between employees and total lives is important, since the latter assumes perhaps 2-3 individuals covered for each employee enrolled.

In other words, 1,003 employees covered likely means perhaps 1,500 - 2,000 actual people covered by those policies...which means that in just one week, Connecticut may already have tripled the total people enrolled in SHOP plans for the full 2014 period.

I've been thinking about this a lot over the weekend. My prior estimate of QHP enrollments through the first week of the 2015 Open Enrollment period (enrollments being defined as "number of covered lives via plans selected, whether the first premium has been paid yet or not") stood at 212,000 "or more". I included the "or more" because some of the state data was not only partial, but only covered a single insurance company within that state. In addition, in some cases the data I have only covers renewals or new enrollments as opposed to both.

So, it's been 3 days since the Great #DentalGate story broke (yes, I'm abandoning my efforts to make #ObamaDentata the Officially Accepted Stupid Media Label for this incident...no one else seems to be running with it, so it seems that slapping "-Gate" onto every scandal/alleged scandal in politics is inescapable these days).

When Alex Wayne of Bloomberg News asked for my response before he broke the story publicly, I said that, assuming the story was accurate, I was "appalled". I stand by that response, because I am appalled regardless of whether it was done deliberately or by mistake.

Unfortunately, there aren't any specific enrollment numbers given out in this article, but the 3rd paragraph includes a hell of an eye-opener...especially given that this is in deep-red South Carolina:

Last year, insurance agents and federally funded navigators were sitting around their computers, hoping to get into the balky website in the first few weeks after it went online on Oct. 1. When they were able to log in, the system moved at a snail’s pace. The rollout was viewed as a disaster for the Obama administration and the early implementation of the insurance mandate in the Affordable Care Act.

This year, the problem has been finding enough time to help the early rush of people who want to either shop for the best policy or go ahead and enroll. At Richland Library, the appointments for enrollment help are booked through the end of November.

OK, not an exact number, but this story ran on 11/20, the 6th day of 2015 open enrollment, so...

Nevada Health Co-op, based in Las Vegas, was created to offer affordable health insurance, and to compete with other companies offering insurance in our state. Since open enrollment began Saturday, the Nevada Health Co-op has been very busy.

Director of Business Development Patti McCoy says they have been enrolling about 100 people a day.

Again, like my initial entries for Illinois and Oregon, this is only for a single insurer out of several operating in the state, so the actual QHP enrollment number is likely considerably higher.

Like the Illinois item, this is only a very partial number because it only relates to the first 2 days for a single insurance provider, but it's better than nothing:

Dr. Ralph Prows, CEO of Oregon's Health CO-OP, said his plan tallied about 500 enrollments during the opening weekend and has not experienced any problems with the back-end process for receiving enrollment data from the exchange.

Oregon and Nevada's data numbers should be interesting to watch since they both dumped their own exchange sites in favor of the federal one at HC.gov, of course...

Looks like New Hampshire is switching from "standard" Medicaid expansion to an Arkansas-like "Private Medicaid Option" program next year...and it includes an enrollment update:

"This waiver is an important part of our efforts to improve the health and financial well-being of Granite State families, businesses and communities through our bipartisan health care expansion plan, "Governor Hassan said. " Almost 24,000 Granite Staters have the security that comes with quality, affordable health insurance because of the New Hampshire Health Protection Program, and if approved, this waiver will allow these people to choose private insurance on the health insurance marketplace."

...The purchase of Qualified Health Plans via the marketplace will be paid for with 100 percent federal funds through December 31, 2016.

Through the 19th of November, 23,975 New Hampshire citizens had enrolled in the New Hampshire Health Protection Program.

4,107 individuals have newly enrolled or renewed their enrollment in a qualified health plan.

735 individuals have enrolled in Medicaid

First, that QHP number is excellent.

As for the Medicaid number, it looks rather low. On the other hand, KY has probably already enrolled just about everyone in the state who qualifies for the ACA expansion program, so perhaps not...there may just not be that many more to add at this point!

Hah...I knew I should've waited a couple more hours to send out the newsletter for the evening...

In the first week of open enrollment, 2,659 new customers signed up for private insurance plans and 8,945 people signed up for Medicaid through Access Health CT, the state’s health insurance exchange.

To reiterate: This is new enrollees only, not renewals:

The figures include people who had not previously had coverage through Access Health. The exchange did not release the number of people who currently have coverage through the exchange and signed up for 2015 coverage.

Oh, yeah, and I'm guessing that #ObamaDentata will mean more clarifications of this nature going forward:

Separately, 123 people signed up for dental coverage sold through the exchange.

Earlier today, in response to #ObamaDentata, Investor's Business Daily wrote an editorial in which they accused the HHS Dept. of flat-out "lying with statistics".

The first part of the piece lays out the basics: HHS claimed the number enrolled in QHPs was 7.3M in August & 7.1M in October, but it was revealed yesterday that the numbers were actually 6.97M in August and 6.7M in October...with the difference being 393,000 dental plans which were effectively double-counted:

This week, Health and Human Services Secretary Sylvia Burwell admitted that her agency had accidentally counted those who'd signed up for stand-alone dental benefits in its health insurance numbers, padding its latest enrollment data by nearly 400,000 — or 6%.

OK, the data is very limited (only 9 states...I left Illinois off because that only includes a single insurance company in the state), and it only runs through the first few days for some states (in fact, Hawaii is only part of the first day), but this at least gives me a starting point to work with.

Based, again, on extremely limited/partial numbers, it's looking like the national total in the first week may be twice as many as the entire first month last year. Amazing what a difference working websites can make...

Anyway, this chart is obviously going to jump around a lot as more numbers come in, and will likely increase dramatically as we approach December 15th...and then again as we approach February 15th. This is where it starts, though.

UPDATE 11/22/14:Only a few hours after I posted this, I received partial data from Kentucky & Connecticut which bumped my estimate for Week 1 even more, to at least 212,000 QHPs.

OK, this is excellent. Minnesota has not only updated their official Enrollment Update page for the first time since #OE2 started, they've also clarified exactly when it will be updated (over the off-season it was scattershot, although they sometimes updated it daily:

Latest Enrollment Numbers

November 21, 2014

MNsure will release 2015 enrollment metrics weekly, and will present a more robust metrics summary to the MNsure Board of Directors at each regularly-scheduled board meeting. During weeks that MNsure is closed on Friday, the enrollment metrics update will be released earlier in the week.

Note: It seems that the mainstream healthcare media has decided to go with the far more boring and obvious "#dentalgate". One of the fringe benefits of being an amateur blogger instead of a professional journalist is that I get to use vaguely-NSFW terminology if I feel like it. So, unless anyone has an objection, I'm sticking with "#ObamaDentata" for now.

HHS on Thursday (Nov. 20) acknowledged that it overstated enrollment by nearly half a million people because it had included both dental and medical health plans in recent numbers, and affirmed that there were 6.7 million people enrolled in health plans as of Oct. 15, or 400,000 less than previously asserted.

After yesterday's Obama Dentata* story broke, people asked whether I'm sticking with my official projections of 12 million QHP enrollments (total) and 10.6 million (paid). The answer is yes, and here's why:

First of all, yesterday I discovered that New York State has a much more aggressive target than I thought: 720,000 QHPs, which would be a whopping 94% increase over 2014 (I thought the 350K increase was QHPs + Medicaid combined, but Dan Goldberg of Capital New York specifically asked and was told nope, that's private QHPs only). It's a pretty tall order, but it's also a pretty confident/bold one. If they pull it off, that's 165,000 more people than I was projecting right there.

To recap: In the initial few days of 2015 #OE2, Massachusetts' actual QHP enrollments averaged about 52% of the total "determined eligible" number. The first official weekly report (with "selected plan" QHPs) will be released Monday, so for the moment I'm going with that ratio daily. With that in mind, it looks like MA may have broken the 10,000 milestone in just the first 5 days!

That's 19,957 "determined eligible" for QHPs. Assuming 52% have already selected plans, that's a total of over 10,300 to date.

Again, for comparison sake, last time around MA only 31,695 people were able to enroll. If my 10.3K figure proves accurate, that's 2,060 per day, compared with just 158/day for 2014...or 13x the rate.

Massachusetts is making up for last year's disaster in spades so far.

In addition, check out the confirmed Medicaid (MassHealth) tally: 16,292 people already.

Yes, Republicans are gleeful about having a new pet issue to attack the ACA with. And yes, this one was indeed either a really, really stupid screw-up or purposeful fudging, depending on whether you believe the official explanation or not.

(Yes, I realize that title may be too clever by half. Anyone know if this is actually an offensive reference?)

OK, I wasn't going to post anything else about this today, really. I was planning on holding off until tomorrow. However, it's turned into a Thing (of course), and Things have a way of sucking the oxygen out of the room. So...

First of all, to reiterate: In terms of how the ACA is functioning, the fact that the net attrition rate has turned out to be 2.7% (6.7 million on October 15th / 8.0M on April 19th = 83.75% retention over a 6 month period) was normal and expected. I thought it was about 3% per month until the "7.3M in August" announcement caused me to drop it down to 2%...and it turns out I was right in the first place, both for August as well as October, when I suggested that the number may have slipped to as low as 6.8 million.

a) the actual number who've been enrolling daily in the off-season is higher than my 9,000/day estimate, or
b) that the attrition rate after the first month is lower than my 3%/month estimate, or
c) more than 90% of enrollees eventually pay their first month's premium, or
c) some combination of all three.

Considering that NYC has around 400 zip codes by itself, this was no doubt a rather Herculean task.

Today, however, they've gone one step further, with a state-wide map of September enrollments by zip code...and when you include the entire state of NY (not just NYC), you're talking about 2,200 zip codes (!) Excellent job!

On it's surface, this article isn't anything terribly special (although it is well-written). It's a piece by a physician who has been protesting North Carolina's refusal to expand Medicaid under the ACA.

The reason I'm calling attention to it is because The Graph was cited in the 3rd paragraph (see that tinly "1" footnote at the end of the first sentence):

Since passage of the ACA, 23 million to 28 million Americans have gained access to health insurance through insurance exchanges, Medicaid expansions, and the mandate that children be allowed to remain on their parents' policies until the age of 26.1 Several studies have shown a very concrete benefit of expanding insurance: reduced mortality.2 If a Medicaid expansion in North Carolina achieved similar results, hundreds of deaths per year could be prevented. Less tangibly, millions of citizens have had a weight lifted from their shoulders and can now feel free to change jobs or pursue less lucrative careers as entrepreneurs or artists, assured that they won't have to go without health insurance.

Washington Insurance Commissioner Mike Kreidler grabbed national attention last year when he broke with President Obama’s efforts to mollify a public upset by canceled insurance plans. Of late, Kreidler has been openly critical of the state’s botched efforts to make repairs to the online insurance exchange.

But Kreidler remains a champion of the effort to make universal health care a reality, and Washington has taken some meaningful steps in that direction. The state has reduced the number of uninsured residents by roughly 38 percent since it expanded who is eligible for Medicaid and opened a new insurance marketplace in October 2013.

This article from the Seattle Times is primarily about the Washington State exchange still having some technical problems, but there's also a key #OE2 enrollment nugget:

Of the 25,000 applications completed on the exchange so far in the first week of the second round, more than 10,000 are for insurance plans while the remainder are Medicaid applications. Officials don’t yet know how many are people renewing their coverage, as opposed to new customers. Roughly 2,000 of the applicants have scheduled their first payments.

There you go: 10K applications, 2K actually selected & enrolled. Since the article was published at around 6pm on Tuesday, I'm assuming that number runs through Monday night.

Their governors might have hated Obamacare, but their attorneys general just love that Obamacare money.

Eleven states that chose not to set up their own health-care marketplaces filed court papers on Monday supporting the legality of federal subsidies that help their residents buy insurance plans through HealthCare.gov.

Those subsidies are being challenged by four lawsuits that claim only enrollees of health-care exchanges set up by an individual state can get that financial assistance, in the form of tax credits.

Illinois lawmakers may have one more chance to approve a state-run health insurance marketplace during the fall legislative session that starts today, and they are under pressure from an end-of-the-year deadline and a pending court decision.

Supporters of creating a state-run website say the impending deadline to receive up to $300 million in federal funding plus a U.S. Supreme Court decision on tax credits due in the spring create urgency. Currently, Illinois residents purchase insurance on the national HealthCare.gov website.

I'm pretty sure that in this case, "applications completed" does refer to actual "plans selected", judging from both the number from a day earlier (1,500) and the context of the quote, although I could be wrong (I also think that's supposed to read "through early Tuesday afternoon...")

Andrew Ratner, a spokesman for the exchange, said it seems to be working well so far. Ratner said 5,324 people have applied and 1,915 applications have been completed since early Tuesday afternoon.

Meanwhile, as of Monday, D.C. Health Link had a little more than 9,000 visits to its website from about 6,300 visitors. The exchange had 708 total applications and 212 plan selections for 249 covered lives. Officials said they were off to a strong start toward their enrollment goals this year, though they've declined to disclose specific numbers.

As I noted yesterday, the good news is that Massachusetts is posting daily metric reports on the new ACA Health Connector exchange, a level of frequency which surpasses even Minnesota.

The (mildly irritating) news is that with all of that data being served up daily, the main number that concerns me here at ACASignups--the "number who've selected a plan"--will only be included weekly, every Monday.

Still, until then I can at least get a rough idea. The most recent official press release stated that 3,600 QHPs had been enrolled in out of 6,972 people "determined eligible" for them, or 52% of the total. This number will bounce around from day to day, no doubt, but it's a reasonable starting point to use until Monday.

So, assuming 52% of "determined eligibles" are consistently actually enrolling in policies, today's dashboard report suggests that the number for the first 4 days has reached over 8,400 out of 16,293 total:

Nice to have an official number, and like the other state-run exchanges which have overhauled their systems, Minnesota's 2015 kickoff is a massive improvement over last year:

Strong Enrollment
Since the 2015 open enrollment period began on Saturday, 1,516 consumers have enrolled in Qualified Health Plans through the MNsure marketplace. By contrast, 406 consumers enrolled in Qualified Health Plans during the first two weeks of the 2014 open enrollment period, meaning MNsure has enrolled four times more people in its first four days than it did last year in two weeks. Also, 765 have enrolled in MinnesotaCare and 2,431 have enrolled in Medical Assistance. MNsure is the only place for Minnesotans to find out if they are eligible for financial assistance such as tax credits, and low-cost or no-cost coverage.

The 51 states (including the District of Columbia) that provided enrollment data for September 2014 reported nearly 68 million individuals were enrolled in Medicaid and CHIP. This enrollment count is point-in-time (on the last day of the month) and includes all enrollees in the Medicaid and CHIP programs who are receiving a comprehensive benefit package.

340,159 additional people were enrolled in September 2014 as compared to August 2014 in the 51 states that reported comparable September and August data.

Looking at the additional enrollment since October 2013 when the initial Marketplace open enrollment period began, among the 49 states reporting both September 2014 enrollment data and data from July-September of 2013, over 9.1 million additional individuals are enrolled in Medicaid and CHIP, approximately a 16 percent increase over the average monthly enrollment for July through September of 2013. (Connecticut and Maine are not included in this count.)

From a state exchange roundup report; I've already reported on every data point they have except for this one out of DC:

By the end of the day Saturday the District of Columbia enrolled 66 people at an event downtown. DC Health Link upgraded this year, including features like providing more information about each health plan. More than 15,000 people enrolled in private plans last year and nearly the same number enrolled on the small business exchange. Health care premiums for 2015 will increase by 11 percent.

This afternoon I was contacted by Erik Wemple, a writer for the Washington Post, to discuss a story about the elusive enrollment data from the HHS Dept. Yes, Sec. Burwell did give out some general First Day metrics on Sunday morning: 500K people logging on, 100K submitting applications. However, that's not the key number that people (including myself, of course) are most interested in.

Unfortunately, I was on the other line at the time (with someone from a different media outlet, as it happens), and I had to pick my kid up from school after that, and wasn't able to get back to the Wemple in time. I guess he had a tight deadline to meet, because shortly thereafter, his story ran:

Those disclosures are fine as far as they go. But Bloomberg health-care reporter Alex Wayne suggests that the data release follow a more systematic format:

New York (MainStreet) -- With Obamacare open enrollment under way for next year, Americans continue to oppose the Affordable Care Act even as new data reveals that many of us don't even know what's in it.

A recent survey, conducted by the Kaiser Family Foundation, asked ten questions about health insurance under the ACA. Nearly 40% of participants got half of the questions wrong, with 8% getting nothing right at all.

In September, the Kaiser Family Foundation looked at insurance premiums for Obamacare's benchmark silver plan in 16 major cities and found, to their surprise, that prices were falling by 0.8 percent on average. On November 11, they updated the analysis with data for 32 more cities — and found that the initial finding held. On average, prices are falling by 0.2 percent.

CLEVELAND, Ohio – A new report released Monday by Universal Health Care Action Network of Ohio (UHCAN) is sharing the challenges people faced during the first open enrollment period through the Affordable Care Act, and is providing suggestions on how to improve access, especially for people living in communities of color.

Based on the findings of the report, conducted with the think tank PolicyBridge and funded by the Mt. Sinai Health Care Foundation, UHCAN is recommending that enrollment navigators and other assisters be more available and accessible in neighborhood and community-based sites. The network is also recommending that follow-up services be provided for people new to insurance, not only to help connect them with a primary care provider, but to make sure they know how to use that insurance.

I was geeked beyond measure when I was told that the all-new Massachusetts Health Connector would be posting daily enrollment reports. Until now, the only state doing this was Minnesota, and they only started doing so (I think) after the end of the first open enrollment period (or close to it).

Sure enough, they've already posted two "dashboard reports" with metrics showing how many Bay Staters had been determined eligible for Medicaid ("MassHealth") as well as the different types of Qualified Health Plans (QHPs), which are broken out into those paying full price, those receiving tax credits (APTC) and those qualifying for "ConnectorCare" which seems to be some sort of special Massachusetts-specific program which is somewhere between the Arkansas "Private Medicaid Option" and Minnesota's "MinnesotaCare" Basic Healthcare Program...except that the "ConnectorCare" enrollees are still categorized as "QHPs" for enrollment purposes.

The reports give daily tallies of how many accounts are created and how many applications are submitted, along with call volume, website traffic and forth.

Yes, I know what you're saying: This is either a joke or a typo; how could Maryland be launching open enrollment a day early when 2015 #OE2 actually started 3 days ago?? Shouldn't that read "3 days late"?

Yes, I realize it's kind of stupid to post The Graph when there's barely anything to Graph yet, but I wanted to set the stage for 2015 #OE2. As you can see, I'm doing it in a much cleaner, more organized way this time--the timeline includes the entire open enrollment period (which is less awkward to do this year since it's only 3 months instead of 6).

I've also overlaid projection lines to show roughly how I expect the QHP enrollment pattern to go--an initial "mini-surge", then a massive spike as the December 15th deadline approaches (anyone who's already enrolled who auto-renews or manually switches to a different policy will be part of this, since they don't want to have a coverage gap in January). I'm assuming roughly 7 million QHPs by 12/15 (or possibly a few days later...it's my understanding that some state exchanges are using 12/18 as the cut-off for January 1st?).

Then things should level out a bit from mid-December until mid-January because all the autorenewals will be accounted for (not to mention the holiday season). I'm figuring perhaps 1 million more; these folks will have coverage starting on February 1st.

OK, this one is a bit vague, but for the moment I'll take it. "Land of Lincoln Health" is an insurance CO-OP which operates, as you'd imagine from the name, in Illinois. I'm fairly certain that's the only state they operate in, so this number should be restricted to IL:

Land of Lincoln has enrolled “several hundred people” since open enrollment began this past Saturday, and the plan is already receiving payments from consumers, said Dorgan, who is in charge of finding and renewing members. About 6,000 people visited Land of Lincoln's website over the weekend with no apparent technology issues—an auspicious start for a plan that hopes to have 50,000 covered lives for 2015.

This is excellent news for another reason as well: Land of Lincoln only scored about 2,500 enrollees for 2014 open enrollment, so they're at something like 14% of their entire 2014 number in just 2 days.

Again, for comparison, during the first open enrollment period, Minnesota enrolled 48,495 people, or 242 per day, so their initial pace is about even with that so far:

More than 500 people signed up for commercial health insurance this weekend through MNsure, the state’s health insurance exchange.

Open enrollment started Saturday at MNsure, and more than 27,000 new and returning users accessed the health exchange website through the weekend, said Scott Leitz, the MNsure chief executive during a news conference Monday in St. Paul. About 2,700 people phoned the MNsure call center for help, and the average wait time was about two minutes, Leitz said.

The first-weekend figures are a good start toward meeting enrollment goals, Leitz said. The number of phone calls this weekend was 10 times the typical volume for MNsure.

Given those significant changes, officials are urging uninsured and insured residents to explore their options. Those who purchased plans through the healthcare.gov marketplace will automatically be re-enrolled, but health care advocates say renewal may not be the best option because the tax credits that subsidize coverage could have changed. And some who signed up last year instead may be eligible for the state's newly expanded Medicaid program.

Officials seemed to have learned from their mistakes—at the very least, the site went through more testing—but there are still questions about what the administration has done to improve the user experience, whether premiums have gone up, whether people will enroll and whether the less-talked-about state-run exchanges are fixed, too.

(Technically speaking Massachusetts' eventual QHP total ended up being around 34,000, but with attrition/etc. it has likely fallen back down to around 32K by now anyway, so that's still a pretty fair comparison).

Sunday morning, the big ACA news of the day was HHS Secretary Sylvia Burwell announcing that over 100,000 applications had been successfully submitted and processed on Day One of the 2015 Open Enrollment Period.

However, throughout the day I noticed that an awful lot of people kept confusing 100K applications with 100K enrollments, which is not the same thing. Even the New York Times made this error (quickly corrected thanks to an, um, anonymous tip). As I noted in my post yesterday morning:

I'm as geeked as any ACA supporter, but some context and clarification is important here. Last year there was a lot of confusion about the distinction between someone:

As I posted last night, most of the ACA exchanges seemed to be running pretty smoothly for the launch this year, with two exceptions: CoveredCA, which was having some sort of serious problems throughout the day (I'm not clear how widespread they were), and the Washington Healthplanfinder, which was actually deliberately taken completely offline after only a few hours, and remained offline until this morning:

The problem was noticed during the site’s first hours of operation on Saturday morning, the first day of open enrollment for 2015 plans. The staff decided to take the site down for repairs at 10 a.m.

The good news is that the issue appears to have been fixed, and it didn't impact too many people (of course, that also means that an unknown number of potential enrollees were lost in the interim). In any event, it looks like we also have an unofficial Day One enrollment number, anyway:

Earlier today I had a rather infuriating exchange with someone who's pissed off at the all-new Massachusetts Health Connector because they dare to require him to (wait for it)...re-enter his personal data this year!! Can you believe it?? The nerve!!

I tried giving a reasonable response: Yes, it's annoying, but there could be plenty of reasons why the MA data has to be re-entered. Perhaps the database was corrupted. Perhaps it was hacked and riddled with backdoors. Perhaps it was just in some sort of weird, proprietary format which couldn't be migrated. Perhaps it could have been, but it would've cost gazillions of dollars and/or time more than it already did. Perhaps the MA exchange officials are incompetent (this last was certainly true for Take One, anyway).

But that wasn't good enough for this guy. He wouldn't let it go; kept pestering me about it for like another 15 minutes on Twitter before I finally told him to talk to the MA exchange and leave me out of it. Then I had to block him because he just wouldn't shut up about it.

Yes, that's right. I'm posting a blog entry about exactly one person being enrolled. Let it never be said that I'm not meticulous in documenting my data:

Saturday was the first day of open enrollment in Maryland and around the nation on exchanges created under the Affordable Care Act for people who do not get health insurance through employers. In Maryland, residents received their first shot at gaining coverage at an enrollment fair in Glen Burnie, hosted by the state's nonprofit partner HealthCare Access Maryland.

Banda arrived at 9:22 a.m., 38 minutes early. She was fourth in line. By 9:30 a.m., about a dozen people were waiting, and organizers decided to get the day started early. Less than an hour later, she became the first enrollee on the state's new exchange website. Her plan will cost her $97 a month, she said, and her co-pay will be zero.

"I feel awesome," she said. "It's a relief. I feel that it's going to work for me."

The state Cabinet for Health and Human Services said in a release that as of 4 p.m. Saturday, there had been 6,200 unique visitors to the Kynect Web site; 2,415 calls handled by the Kynect contact center; 504 applications submitted; and 368 individuals who had newly enrolled in a qualified health plan.

In addition, 70 visitors to the Kynect store at Fayette Mall in Lexington had completed 33 applications for new coverage.

The "newly enrolled" is important as well, to distinguish it from current enrollees renewing their policies. Hopefully all of the exchanges will be sure to clarify this, but...

Top contributor deaconblues is back in action with three updates today: First up, Hawaii:

HONOLULU — Hawaii's health insurance exchange enrolled more than 40 people on the first day clients were able to sign up to be covered next year.

Another 60 applied for financial assistance to pay for premiums as of mid-afternoon, Jeffrey Kissel, the CEO of Hawaii Health Connector, said Saturday.

The insurance exchange expected to serve over 1,000 clients, either online, over the phone or in person by the time it closed for the day at 8 p.m.

As db notes, and as I noted in my Vermont/Massachusetts post this morning, the numbers may be tiny but it's symbolically very important, especially for the exchanges which had so many technical problems last year. Hawaii didn't get nearly as much press as OR, NV, MA, VT or MD, but they did have severe problems as well.

Combine that with the fact that it's such a small state which already had such a low uninsured population to begin with, and enrolling "only" 40 people or so on Day One is still an important starting point for their 2015 narrative.

Vermont Health Connect processed 50 new applications and 201 renewals by Saturday at 1 p.m. The exchange was working well with some isolated minor issues in the morning that were quickly resolved, he said.

I've rantedseveral times before about the importance of current Obamacare private policy enrollees making sure to actually visit the exchange website, shop around, log into your account and manually re-enroll for 2015, even if nothing has changed at your end (ie, no changes in income, dependents, residence etc).

There are many reasons NOT to auto-renew, most of which are financial in nature. The short version is, you could easily end up paying more than you thought next year by not switching (in addition to premium changes, your tax credit might drop even if your income hasn't changed due to how it's calculated), and you could pay substantially less next year if you do switch to another policy (premiums are actually dropping in many markets).

OK, I'm as geeked as any ACA supporter, but some context and clarification is important here. Last year there was a lot of confusion about the distinction between someone:

creating an account

submitting an application

selecting/committing to a plan, and

paying their first month's premium.

The 8.02 million figure through April 19th touted by the administration last spring represented 3) Selecting a plan.

Of that, the actual number who followed through and 4) paid their first premium (thus activating--or "effectuating" to use the industry lingo--their policy) ended up being roughly 88%, or around 7.1 million.

Yes, I know, I know: Who wouldn't want to spend an hour watching Andrew Sprung (aka xpostfactoid1) and myself discuss the minutiae of the 2015 Open Enrollment Period, my projections from the other day and the design/usability improvements at Healthcare.Gov?? Contain yourselves, people!!

(OK, OK, you don't have to watch the full hour--it's broken into 5-8 minute snippets)

However, I can say that based on my (very limited) poking around the web, it appears that not only is Healthcare.Gov doing fine, so are most of the state-run exchanges...except for two of them (and not the ones you'd think):

California: I heard anecdotal evidence that CoveredCA was having some significant issues on opening day, but it wasn't until I checked their Twitter feed and saw a series of posts like this that I grew concerned:

Washington State: The WAHealthplan Finder issued this notice this afternoon:

During the first open enrollment period, the official data releases from the various exchanges ranged all over the place.

HHS, of course, only issued monthly reports, without giving any official data in between (that is, until the numbers started looking good, at which point they issued milestone press releases of "3 million", "5 million" and so on, although even then they didn't give exact numbers or dates).

Some of the state exchanges stuck with monthly numbers as well (Colorado), while others gave out data roughly weekly (Nevada, via Twitter), bi-weekly, or whenever they happened to feel like it (most of the other states). As things ramped up towards March/April, some states started issuing regular weekly updates (including Oregon, which is ironic given all of their technical problems).

Unfortunately, I'm not sure whether "processed completed applications" means actual enrollments or just accounts created. Presumably HHS will provide better clarity on this sort of language (and quickly) going forward. Plus, of course, a single policy enrollment could have 2, 3 or more people in a household.

However, I'm happy to report the very first official enrollment update is also already available, and it's out of Vermont, one of the states with a highly-troubled exchange last time around!

During the 2014 Open Enrollment Period, the federal exchange at Healthcare.Gov enrolled 68% of the 8.02 million total through April 19th. However, it didn't start out that way; 68% was the cumulative percentage. Due to the severe technical problems at HC.gov (along with some of the state exchanges), during the first month, the federal site only made up 25% of the total. As technical problems were worked out, this ratio shifted dramatically as follows:

October: 25% Federal, 75% State-based

November: 43% Federal, 57% State-based

December: 59% Federal, 41% State-based

January: 65% Federal, 35% State-based

February: 72% Federal, 35% State-based

March/April: 75% Federal, 25% State-based

As you can see, once HC.gov worked the bugs out, it took off bigtime, and was enrolling 75% of the total by the time the Big Surge came at the end.

Health industry officials say ObamaCare-related premiums will double in some parts of the country, countering claims recently made by the administration.

The expected rate hikes will be announced in the coming months amid an intense election year, when control of the Senate is up for grabs. The sticker shock would likely bolster the GOP’s prospects in November and hamper ObamaCare insurance enrollment efforts in 2015.

...The insurance official, who hails from a populous swing state, said his company expects to triple its rates next year on the ObamaCare exchange.

Because Ed Lyons is the same guy who wrote The Health Connector Autopsy Report, which documented everything that went wrong with the MA ACA exchange project, from before the beginning until after the end. I mean, everything.

All 31,000 words of it.

It's difficult to get across just how in-depth, comprehensive or well-researched/documented that report is. It's also important to understand that a) to the best of my knowledge, like myself, Mr. Lyons didn't do it for money or for fun; it was something of an obsession for him. It should also be noted that Mr. Lyons is a Republican.

OK, the numbers have barely moved, and technically this update is missing 3 days (it only runs through 11/11 instead of 11/14), but MNsure has been the only exchange, federal or state, which has provided an almost odometer-like frequency of off-exchange updates.

Yes, of course it's blank. As you can see, I'm doing things a bit differently this time around: I'm presenting the full enrollment period all at once (doable since it's only 3 months instead of 6), and I'm including the official "targets" from HHS, CBO and myself on the right side.

Underneath, just for posterity, I've posted the final version of the 2014 Graph.

55% of Americans who currently lack insurance say they plan to sign up for coverage while 35% of the uninsured say they will not get insurance and instead pay the fine as required by the Affordable Care Act, also known as "Obamacare."

Among those who bought a new policy through a government exchange this year, 68% say they will renew their current policy, while 7% say they plan to get a different policy through a state or federal exchange. Meanwhile, 15% say they will get a different policy from another source, and 2% say they will drop their health insurance altogether.

Regular readers know that the current QHP enrollment tally for the ACA, which started at around 7.1 million on May 1st (around 900K of the 8.02 million who enrolled through 4/19 never paid their first month's premium), gradually increased over the summer to a peak of around 7.3 million as of August 15th before dropping back again into autumn...right back down to around 7.1 million again as of October 15th.

At the time, ACA critics Megan McArdle and Bob Laszewski were speculating that there would likely be a substantial drop-off after the August peak due to the "3 month grace period" factor: That is, under the ACA, insurance companies aren't allowed to kick people off of their policies for non-payment of their premiums until after that payment is at least 3 months past-due. Their reasoning was that a whole bunch of people had enrolled in the spring, made a single payment but then blew it off for the rest of the summer, mooching 4 months worth of healthcare coverage for the price of one before getting kicked to the curb.

I thought it was an interesting theory which would have at least explained why the 7.3M figure was abruptly given out after months of radio silence from HHS. All year I've only found a single data point about the "3 month grace period" item: Arkansas, which reported only having 2.1% of their enrollees in that status a month or so ago. Still, 2.1% out of 7.3 million is 146,000 people, so it could have been substantial.

Gov. Peter Shumlin is “hopeful” that Vermont’s health care exchange website will be online in time for the open enrollment period that begins Nov. 15. But he didn’t sound certain Friday that his team will make the deadline.

“I’ve been discouraged so many times by this website that I’ll believe it when I see it,” Shumlin said on Vermont Edition Friday. “What I’ve been told by my folks who are working really hard on this is that we’ll be ready for open enrollment on Nov. 15.”

In the past, I've pointed out that the actual number of policies which were cancelled last year due to not being compliant with ACA requirements was far, far less than the 5, 6 or 7 million that people were hollering about. In the end it appears to only have been around 1-2 million at most, with the rest being extended by 1, 2 or 3 years via President Obama/HHS's "waiver/grandfathering" allowance.

Of course, that does mean that there will be another chunk of policies cancelled this year, and a smaller number next year, with perhaps a handful left over for 2016...at which point everyone should be on a fully ACA-compliant Qualified Health Plan (QHP).

When I posted about the HHS Dept. announcing that a) 7.1 million people were still currently enrolled & paying for exchange QHPs as of October 15 and b) that they also issued an official projection of somewhere between 9.0 - 9.9 million enrolling during the 2015 open enrollment period, I only saw what was included in the official press release.

This is a pretty short article, and it pretty much covers the bases, so I don't have too much to add...

As New York gears up for the Obamacare open-enrollment period that begins on Nov. 15, state officials have a vested interest in making sure things go smoothly. The success of health care reform in New York will be measured by how many residents maintain their coverage or sign up for the first time.

Just over 75% of those who used the state's new Obamacare exchange last year would recommend it to others, according to a new survey. But 92% of respondents who used the exchange to become newly insured were satisfied with the coverage, according to the survey, released Monday by the New York State Health Foundation.

However, there is one additional point I should add. Remember that ridiculous Bankrate survey I posted about yesterday which claimed that over half of ACA enrollees don't plan on using the exchanges again this year? Well...

Faced with a decision on whether to enroll again, 92% of respondents said they are at least somewhat likely to renew their coverage.

Haven't heard much news out of Hawaii of late, so this is a nice surprise:

Nov. 11--Health insurance rates for nearly 13,000 individuals will rise Jan. 1, while close to 33,000 people may be pleasantly surprised to see premium decreases.

The state Insurance Division has approved an average 9.2 percent rate hike for 9,600 individuals covered by Kaiser Permanente Hawaii and 3.8 percent increase for 3,141 members with the Hawaii Medical Service Association.

Kaiser also got the green light to drop rates by 2.8 percent for 4,800 small businesses with roughly 26,200 members at the start of the year, while HMSA received approval to cut rates by an average 6.2 percent for 6,527 individuals.

When I last checked in on ACA Medicaid expansion in California back in mid-September, it had reached a whopping 2.2 million...or possibly as high as 2.55 million, depending on whether the number included a massive backlog of 350,000 CA residents.

Well, it now seems that not only has that question been answered, but the grand total is a bit higher yet: 2.6 million low-income Californians can thank Obamacare for their newfound healthcare coverage:

The state Medi-Cal system has taken on 2.7 million more Californians since October 2013.

That's an increase of 31% from the 8.6 million previously enrolled. The jump brings the current number of Californians in the Medi-Cal program to 11.3 million -- roughly 30% of the state's population. Medi-Cal is California's Medicaid program.

Obamacare may not have played as great a role on Election Day as predicted, but President Obama's signature legislation has assumed a larger than anticipated role somewhere else this fall: health-sector stock performance.

As third-quarter earnings reports roll in, the improvement in profits that hospitals and insurance companies attributed to the law three months ago as being maybe no more than a one-time pop are looking more durable.

"People are coming around to the idea that maybe it's good,'' said Les Funtleyder, portfolio manager at New York hedge fund Esquared Asset Management and a former Wall Street health-care analyst. "Maybe it's not a flash in the pan but a theme going forward."

During open enrollment, people can sign onto their employer’s health care benefits plan, or, if they’re already enrolled, change plan options. For most companies with a fiscal year ending Dec. 31, open enrollment runs from late October to late November.

An October survey from health care think tank Kaiser Family Foundation found that 89 percent of the nation’s uninsured have no idea that open enrollment through the law’s insurance exchanges starts Saturday.

Two-thirds of the uninsured said they knew “only a little” or “nothing at all” about the state and federal exchanges through which people can buy subsidized coverage. And more than half — 53 percent — said they didn’t know that federal tax credits could help them pay for a plan.

Those survey results are a problem because they mean the consumers who are supposed to benefit most from the Affordable Care Act may be less likely to take advantage of the assistance the law provides.

I admit to being astonished by this. I figured that even those who hate the ACA (well, they hate "Obamacare", not "The Affordable Care Act", even though it's the exact same thing) at least know when the open enrollment period for it starts (if only so they can criticize the start date for being moved to 11/15 for political reasons).

Hawaii Public Radio (hey, what's up with their exchange website anyway? We heard a lot about Maryland & Massachusett's overhauls, and Oregon & Nevada moving to HC.gov, but not so much about Hawaii, which was also having nasty technical issues...) posts a list of 5 things people should remember going into the 2nd Open Enrollment Period...

Here's a quick checklist for people who don't get their health insurance at work and plan to shop for coverage on the health law's online exchanges. Enrollment starts Nov. 15, but you can start kicking the tires now.

Compare plans and prices at HealthCare.gov or, if your state has its own exchange, shop there to find out which coverage is best for you. And you may be eligible for subsidies to help pay your premium.

Keep these five things in mind as the three-month open enrollment period begins.

This site is so much about number-crunching that the human factor often gets lost in these parts. Every once in awhile I try to remind myself (and my readers) of that, and with #OE2 coming up in just 3 days, this seems like as good a time as any:

The Affordable Care Act may have saved Nehemiah Ankoor’s life, and the health care law helped Carol Jackson get her life back.

The second enrollment period for private health insurance subsidized through the federal law will take place Saturday through Feb. 15. Ankoor and Jackson, Springfield-area residents who previously were uninsured, signed up for coverage during the first enrollment period, which ended March 31.

They said they hope rhetoric from critics of the law doesn’t discourage uninsured people from applying for what, to them, turned out to be a godsend.

“Obamacare’s a great thing,” Ankoor, 22, said of President Barack Obama’s signature legislative achievement. “It’s helping a lot of people who you wouldn’t think it would help.”

I haven't done these average-rate-increase posts in a while, but this one came across my screen today so I figured I should post about it.

Back in August, Washington State announced that they had final approved rates on the 90 plans being offered on the WA exchange, with an average increase of 1.9%. However, I didn't know what the market share breakdown was at the time, so I couldn't tell whether that was weighted or not.

Bankrate, according to their website, is "the Web's leading aggregator of financial rate information, offering an unparalleled depth and breadth of rate data and financial content." I've never heard of them before, but this is certainly possible.

However, a few weeks back they published the results of a survey in which they concluded that 51% of those who used the ACA healthcare exchanges last year don't plan on doing so again this year. In short, they're making it sound like up to half of the 8 million people who enrolled through last April (7.1 million of whom were still enrolled as of October 15th) plan on bailing this time around.

Naturally, various right-wing news outlets like TownHall and the Daily Caller pounced all over this survey, claiming (again) that this proves that Obamacare is dead, dead, deader than dead.

With all the Open Enrollment Period changes for 2015 (#OE2), it can get confusing to follow where you're supposed to go to buy an ACA-compliant healthcare policy this time around (especially if you qualify for tax credits to help pay for it, which includes a good 85% or so of the people enrolling). Two states moved from their own websites over to Healthcare.Gov; one did the opposite; and still others have a "split decision" where you visit one site for individual/family policies and another for small business policies.

Over at The New Republic, Jonathan Cohn has a must-read which summarizes, state-by-state, just how ugly things could get if the Supreme Court 1) does indeed rule in favor of the plaintiffs in King v. Burwell; 2) does rule that all ACA tax credits in the 36 states not running their own marketplaces (or possibly as low as 34 or as high as 37, depending on how the court defines "NOT established by the state") have to stop immediately; and 3) neither my own "Denny's Grand Slam Breakfast" solution nor the "State Exchange Two-Step" workarounds end up coming to fruition.

Those who signed up for insurance during the first year of health care reform may think they can avoid open enrollment this fall, but that may not be the best choice because of a tax credit formula in the federal law.

Since federal subsidies are based on a formula that reflects the cost of certain insurance plans, and those costs have actually gone down for 2015, some people will see the amount the federal government contributes toward their insurance go down as well.

More than 350,000 more Oregonians received subsidized or government-paid health coverage last year than the year before, due to expanded income standards for the Oregon Health Plan as well as new tax credits to reduce private health plan premiums.

Maryland officials say about 9,000 people have browsed for health insurance plans so far on the state's newly designed health care exchange website.

Carolyn Quattrocki, the exchange director, said Monday the website is working smoothly, and officials are pleased with the number of people who have started shopping. It opened on Saturday, ahead of Sunday's scheduled opening.

An architect of ObamaCare on Tuesday said he regretted his 2013 comment that a "lack of transparency" and the "stupidity of the American voter" helped Congress pass the healthcare law.
Massachusetts Institute of Technology Professor Jonathan Gruber made his first public comments on MSNBC after conservative media unearthed a video clip over the weekend of him discussing the healthcare law.

Those entering the marketplace to downgrade, upgrade or buy insurance for the first time will have to give it a little more thought. In addition to the expected complications of switching health insurance, the Department of Health and Human Services reports that consumers will have 25 percent more options this year.

But that’s not the only thing that's changed. Consumers, doctors and insurance agents have all learned a lot over the past year. If you’re getting into the health insurance marketplace for the first time, here’s what’s important to know.

Smedsrud is chief executive of HealthCare.com, which holds a seemingly invaluable piece of Internet real estate these days. And he’s looking to make the most of it.

...If that sounds a lot like the government’s official portal for purchasing health care, that’s pretty much the idea. And it doesn’t look that different from HealthCare.gov. Stock photography of smiling people? Check. The promise to help someone find the right insurance plan for them? Yes.

Of course, as it turns out, the actual QHP enrollment as of mid-October turned out to be around 7.1 million anyway, making some of my points moot, but they're food for thought since 7.1M is still less than 7.3M (which in turn, of course, is less than the 8.0M from April).

Last week, I posted a major entry in which I painstakingly pieced together the current QHP enrollment data from 16 states in an attempt to extrapolate what the current national enrollment figure stood at as of October. Since last spring, the only data point that HHS had given out was that 7.3 million were enrolled as of August 15th; I was trying to calculate how many were still enrolled 2 months later, after adding "special life event" enrollments and subtracting people who dropped their policies for other assorted reasons.

In addition, there was the question how much the "3 month grace period", "citizenship/immigration data" and the "income data discrepancy" issues would contribute to the attrition rate, as people were dropped due to failure to continue payments or for not being legally eligible for the policies.

Yup, that's another 16,000 Michiganders who are royally hosed if the Republican Party gets their way and repeals the ACA. The total is now up to around 662,000 people state-wide if you combine Medicaid expansion and those receiving QHP tax credits:

Healthy Michigan Plan Enrollment Statistics

Beneficiaries with Healthy Michigan Plan Coverage: 449,949
(Includes beneficiaries enrolled in health plans and beneficiaries not required to enroll in a health plan.)

As you can see, there are only cosmetic changes at this point. A week or so ago, I had estimated that the number of current QHP enrollees had likely dropped from 7.3 million as of 8/15/14 down to somewhere between 6.8 - 7.0 million. However, according to the HHS press release, the actual number "as of October" stood at 7.1 million. I don't know if that means the beginning, middle or end of October, but let's assume it's somewhere in the middle, or October 15th. [Update: HHS confirmed that this number does indeed run through 10/15].

While the CBO was still projecting a total of 13 million people enrolling (or re-enrolling) through the ACA exchanges by the end of 2015, the HHS Dept. is issuing a much more cautious range of 9.0 - 9.9 million. They're basically saying that the CBO's 13M was based on the assumption that it would take about 3 years to ramp up to the eventual 25M total, but they now feel it will take either 4 or 5 years to ramp up, meaning 2015 should see either 11.5M (assuming 4 year ramp-up) or 9M (assuming 5 year ramp-up).

Whether you see this new projection as good or bad news really depends on your POV. On the one hand, if it does prove to be accurate, they'll catch a lot of flack for "walking back lofty earlier projection", bla bla bla, and the GOP will use this as yet another opportunity to attack the ACA as "failing" etc (ignoring the 9-10 million people who will be on the exchanges, the millions more on Medicaid thanks to the ACA, the protections in place for everyone else, and so on and so forth).

On the other hand, if the 2015 enrollment does end up meeting or beating the CBO's original projection of around 13 million (or even coming close), the administration will be able to crow from the rooftops about kicking butt even more than they did this year (when the final number ended up beating the original 7M figure even after all the start-up technical problems and even after subtracting out those who didn't pay their premiums).

Connect for Health Colorado has just released their final ACA exchange report prior to the 2015 open enrollment period starting up (it runs through October 31st). The top of the line numbers aren't surprising: 2,206 more people enrolled in private QHPs last month, while the SHOP (small business policy) enrollment total went up a mere 4 people (from 2,517 to 2,521).

The QHP rate was 71 per day in October, down from 126 per day from May through September and from 627 per day during the 2014 open enrollment period. This is hardly surprising; a lot of people are likely to decide to "stick it out" for the final 1-2 months of the year and wait until Nov. 15th to enroll in a policy that kicks in on January 1st instead of going through the trouble of enrolling in a policy that will have to be renewed or changed a month or so later anyway.

UPDATE: Someone pointed out that the more likely reason is that ValuePenguin/HealthSherpa are still listing the 2014 pricing only for most states.

Basically, ignore everything below. I would just delete the entire post but it is important to call attention to the fact that both of these 3rd-party sites are still listing 2014 pricing. ValuePenguin has a "2015 Preview" checkmark next to 11 states (you can choose between 2014 and 2015 when you go to a zip code in those states), but HealthSherpa.com doesn't seem to make it clear at all which year you're looking at pricing for.

I've already contacted both sites and strongly suggested that they make it crystal-clear on the actual rate pages whether the pricing is for 2014 or 2015.

UPDATE x2: To their credit, ValuePenguin.com has added "2014 Plans" prominently to the top of each state listing to make it more obvious. HealthSherpa.com, however, still doesn't really indicate which year their policies are for anywhere that I can see.

UPDATE x3:HealthSherpa.com has also now added a note at the top of the site clarifying which year the plans shown are for.

UPDATE: It took me awhile to find this link from the home page of HC.gov, but it turns out it's the very first one ("Get Coverage") in the top left corner. You have to enter your state first because they want people from states using their own exchange such as California, Colorado, Kentucky etc. to be directed to the correct website.

UPDATE x2: OK, they've actually already changed the home page to also include a big "See Plans & Prices" button in the middle of the page as well:

A few key things to note right off the bat:

From a technical/design POV, the new site is indeed like night and day from where it was a year ago. The new site is fully mobile-responsive, loads very quickly, extremely streamlined data entry, the ability to edit any/all info on the fly, and you can choose from multiple filtering criteria via Amazon-style "filtering" instead of just one at a time. That is, last year you could compare metal levels, companies, premium ranges, PPOs vs. HMOs and so on...but only one of these sets of criteria at a time. Now, you can "drill down" to the specific types of policies that you're interested in, or remove certain filters to check them out another way. Very nice.

Health Insurance Marketplace offers tool to help consumers review their plan options for 2015
Consumers should visit the HealthCare.gov window shopping tool to learn about their plan choices. This year there are even more plans on the market than last year.

Note that the actual enrollment capability won't be available until after November 15th (actually, they're rolling it out in stages this year, which strikes me as very wise given the technical problems MD had last time around:

Nov. 15 -- The first HealthConnectNow! sign-up event will be held. About 25 sign-up events are being scheduled throughout Maryland -- four times the number held during the first open enrollment. Details about times, dates and locations will be announced in the coming weeks.

Her point is simple: While progressives may hate much of what he's done in his first term, unlike so many of his ultra-right wing nutbag colleagues, Gov. Snyder has at least shown the occasional moment of decency. Setting up a state-run ACA exchange for Michigan to ward off the fallout from a harmful SCOTUS decision on the King vs. Burwell case would be another such opportunity, which would play directly off of his successful (if belated) push to expand Medicaid for almost half a million Michiganders.

Things have been so crazy this week between the horrific midterm election results and today's unexpected SCOTUS/King/Halbig announcement that once again, my in box is crammed full, so here's some quick takes:

"I definitely feel we need to expand Medicaid in South Dakota, I think it'll help a lot of people who really struggle with their healthcare costs, I think it'll help strengthen individuals in our society, people who are on Medicaid aren't just people who aren't working or don't do something to contribute to society, they're hard working people who had bad things happen to them from health reasons," Matt Barker said.

"I know it's going to be biased, but I think for the most part I think it's good to help families who do need that assistance," Jake Gourley said.

"I think what we're starting to see in some of the states that have already expanded it that there are more benefits than costs to it, it would be foolish for us not to expand it," David Starks said.

Things have been so crazy this week between the horrific midterm election results and today's unexpected SCOTUS/King/Halbig announcement that once again, my in box is crammed full, so here's some quick takes:

...A chain email claimed that more than 214,000 American doctors are "opting-out of Obamacare exchange plans." That is based on a survey of a select group of doctors and even the makers of the survey said it can’t be extrapolated for the entire country. Further, of the doctors responding to the survey, 42 percent said they weren’t participating in marketplace plans because they were never asked to, not because they were "opting out."

The estimate is the result of a flawed methodology and a misreading of survey data. We rate the claim False.

Back in early July, I made a simple proposition which could conceivably mitigate the otherwise severe damage to the Affordable Care Act (as well as to the lives of millions of Americans, the entire healthcare industry and, indirectly, the entire U.S. economy) in the event that the Supreme Court ultimately rules for the plaintiffs in the federal Halbig/King cases.

I called it the "Denny's Grand Slam" solution (alternately the "$360 Solution" or the "GoDaddy Solution"...take your pick), which basically involved states which are currently having enrollments run through the federal exchange set up a bare-bones "exchange" of their own by essentially filing some simple paperwork, registering a domain name for $9.95 with a basic splashpage and then repointing the whole damned thing right back to Healthcare.Gov for the actual enrollment process.

The Healthcare Twittersphere is all abuzz today with the surprising news that the Supreme Court has agreed to take up the King vs. Burwell case regarding Affordable Care Act tax credits for people who enroll thorugh the federal exchange (Healthcare.Gov). (The King case is sort of the kid brother to the Halbig vs. Burwell case, but they're essentially about the same issue).

All sorts of people on both sides of the issue who are much smarter than I about the legal aspects of this case are furiously posting their take on what's likely to happen after the SCOTUS issues their ruling, which I understand wouldn't happen until sometime next summer (they've agreed to take up the case, but I don't think they start hearing arguments for a few months, and then they bop it around for awhile before issuing their final ruling).

Of course, even if the SCOTUS does rule for the plaintiffs in the end, it's very likely that they'll include a note that basically tells Congress "You know, there's an easy way to fix this; just go over section 1401 with a dab of liquid paper and revise the sentence to read "...enrolled in through an Exchange established by the State or the Federal Government" or whatever.

That would be a completely reasonable solution...if there was a snowball's chance in Hell that Congress would do so. Obviously the GOP would never let it go through (assuming that they hold the House and/or take over the Senate), so the clusterf*ck would ensue.

However, depending on what "established by" and "facilitates" are defined as (see section 1311 as referred to in the passage above), it seems to me that there's a different, equally simple (if utterly stupid) possible resolution which would cost no more than $358.20!

Yesterday, in my Big Exclusive Post® about the number of people currently enrolled in exchange QHPs appearing to have dropped down to a bit below 7 million, I noted that based on the 15 states for which I have current enrollment data from September or October (plus 1, Oklahoma, from August), it looks like the national total is right around 7 million on the nose at the moment. However, if you throw Florida into the mix, it drops noticeably, making it look more like 6.8 million.

I also noted that there are two problems with the Florida data: First, that it's had significantly more dropoff (22.5%) from the official April figure than any of the other states listed (with the exception of Nevada, which has had its own technical headaches to the point that it's dropping its exchange entirely).

Even more problematic is that this 22.5% "drop" was supposedly only as of June 30th (it comes from Florida's 2015 policy rate request filing report from the insurance companies operating on the federal exchange).

This makes Florida an incredible outlier; take another look at the chart:

I still stand by this, but an extensive discussion with Jed Graham of Investors Business Daily made me realize that presenting it this way can lead to confusion, because I'm essentially mixing together two different estimated numbers (% paid & attrition rate), each of which may vary widely from state to state, instead of simply comparing the number of people currently enrolled against the 8.02 million who had enrolled (whether paid up yet or not) as of April 19th.

Amazing. Even with things ramping up for #OE2 (Open Enrollment Period 2), and even with the midterm elections overwhelming everything for the past few weeks, Minnesota continues to quietly plod along, racking up the ACA enrollments along the way:

OK, that was unexpected. After a solid month without any updates, last week CoverOregon, being dismantled even as we speak as the state makes the move to HC.gov for #OE2 (Open Enrollment Period 2) suddenly issued a new update. I figured it was their last hurrah before going silent, but it seems they've decided to put out one (or possibly 2?) more updates before going to the Great Beyond:

I'll have much more to say about the impact of yesterday's disastrous election on the ACA and healthcare coverage in general tomorrow, but for the moment let me just note something about the GOTV effort here in Michigan, which was focused on getting about 900,000 Democrats who showed up in 2008 & 2012 but not in 2010. Here's how that worked out:

Schauer actually did receive over 190,000 more votes than Virg Bernero did 4 years ago (about 15% higher), and Snyder's vote tally was down about 270,000 from 2010 (about 14% lower)...but it wasn't nearly enough. Schauer still lost by about 130,000 votes.

There are two threads of conventional wisdom heading into Tuesday's midterm election. The first is that the election doesn't much matter. Regardless which party controls the Senate, President Barack Obama will still occupy the White House, which means gridlock will remain, if not escalate. The second is that, when it comes to Obamacare, the status quo will remain in place for at least the next two years. Senate Republicans may push for repeal votes. But Obama will veto them. Smaller reforms may pass. But the law will mostly remain intact.

When I wrote about the Halbig case earlier this summer (along with its kid brother, the King case), I was pretty sure that the Supreme Court wouldn't even get around to taking up the case (if they did at all) until next year. However, there's a chance that they might take up the second of these (King v. Burwell) this year after all...although the final decision still probably wouldn't come out until after OE2 is over next spring:

As I noted this morning, between the impending election on Tuesday, the upcoming 2nd Open Enrollment Period (henceforth to be designated "OE2" or hashtag #OE2), and a serious technical crisis with my day job which I've had to spend the past few days cleaning up, I have upwards of 150 ACA/Obamacare-related emails clogging up my In Box.

Most of them are worth a mention, but there's no possible way I can do a full entry/commentary/analysis on most of them, so I'm just doing roundup-style summary mentions:

A new report by Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University examines the challenge of maintaining enriched health care for pregnant women who are enrolled in Covered California and who are also eligible for Medi-Cal, which includes the Comprehensive Perinatal Services Program (CPSP). The CPSP, whose roots are in one of the nation's most successful programs ever developed for low-income pregnant women, makes enriched maternity care available to pregnant women facing elevated health, environmental and social risks on account of their economic status.

As I noted this morning, between the impending election on Tuesday, the upcoming 2nd Open Enrollment Period (henceforth to be designated "OE2" or hashtag #OE2), and a serious technical crisis with my day job which I've had to spend the past few days cleaning up, I have upwards of 150 ACA/Obamacare-related emails clogging up my In Box.

Most of them are worth a mention, but there's no possible way I can do a full entry/commentary/analysis on most of them, so I'm just doing roundup-style summary mentions:

As I noted this morning, between the impending election on Tuesday, the upcoming 2nd Open Enrollment Period (henceforth to be designated "OE2" or hashtag #OE2), and a serious technical crisis with my day job which I've had to spend the past few days cleaning up, I have upwards of 150 ACA/Obamacare-related emails clogging up my In Box.

Most of them are worth a mention, but there's no possible way I can do a full entry/commentary/analysis on most of them, so I'm just doing roundup-style summary mentions:

Consumers in Georgia and three other states who were helped by navigators for the 2014 insurance exchanges tended to be people of color who were not financially secure, a recently released report says.

Navigators, who are specially trained in the provisions of the Affordable Care Act, popularly known as "Obamacare," provide face-to-face, in-person help for consumers seeking information about health insurance policies in the state exchanges, also called marketplaces.

Between the impending election on Tuesday, the upcoming 2nd Open Enrollment Period (henceforth to be designated "OE2" or hashtag #OE2) and a serious technical crisis with my day job which I've had to spend the past few days cleaning up, I have upwards of 150 ACA/Obamacare-related emails clogging up my In Box.

Most of them are worth a mention, but there's no possible way I can do a full entry / commentary / analysis on most of them, so I'm just doing roundup-style summary mentions: